Lifestyles

Immunizations: Victims of their own success

By Dr. Tony Cappello

NCHD public health director

Posted:
08/11/2016 07:04:26 AM MDT

Since the established use of the vaccine, immunizations have played a momentous role in public health disease control and are extremely effective in both eliminating and significantly reducing the occurrence of common life-threatening illnesses. Every day, vaccines continue to save countless lives, significantly reduce medical costs, and prevent untold and unnecessary childhood suffering. In fact, the dramatic impact immunizations have had on the public's health can be observed firsthand in the total reductions of annual morbidity during the 20th century and the fact that the U.S. has seen a 100 percent decrease in deaths related to smallpox and polio and a 99.9 percent decrease in deaths related to measles, mumps, rubella, and diphtheria; just to name a few.

Even with such success, childhood immunization rates are still considered suboptimal and we continue to see outbreaks of vaccine-preventable diseases across the country. Much of this can be directly related to the unsupported complacency surrounding the effectiveness and safety of vaccinations, often by celebrity figures or other self-proclaimed experts. Unfortunately, this movement has now influenced a non-scientifically based controversy among parents of whether or not to vaccinate their children, with no credible science to support the latter. Add to this a new generation of parents (and even physicians) who have not experienced the devastating effects of vaccine-preventable diseases, and this creates a false sense of security and a general misunderstanding related to the tangible benefits of immunizations.

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The reality is simple, without continued and routine vaccinations, the incidence of vaccine-preventable illnesses will rise again. This is supported with the epidemiologic and historically proven law of public health that infectious diseases can be effectively controlled by upholding adequate herd immunity within a community. Without a strong herd immunity, a disease will more readily and rapidly spread within a population and sufficient public health protection can be lost.

Dr. Tony Cappello NCHD public health director

In highlighting the epidemiology of two important vaccine-preventable illnesses, it is easy to see how proper immunization practices can help prevent the dramatic reoccurrence of vaccine-preventable illnesses. Pertussis (also known as whooping cough) is an acute infectious disease caused by the bacterium Bordetella pertussis. It was one of the most common causes of morbidity and mortality among children prior to the availability of vaccination. Between 1940 and 1945 alone, more than one million cases of pertussis were reported and the annual infection rate hovered around 175,000 cases per year, which is about 150 cases per 100,000 people. After the availability of the pertussis vaccination in the 1940s, the cases of illness continued to decrease to an average of about 2,900 cases per year (1 per 100,000 people) during the 1980s and 1990s. However, it was during the 1980s that health professionals began to see an increase in the number of pertussis cases and now in the 2000s, many states are reporting pertussis outbreaks and the number of cases continue to rise exponentially, particularly among the unvaccinated.

Measles is another important vaccine-preventable disease that has been on the rise. Measles is an acute viral disease and prior to 1963 there were approximately 500,000 illnesses and 500 deaths reported annually in the United States, with considerable outbreaks occurring every two to three years, however, the actual number of illnesses were estimated to be around three to four million. After the introduction of the measles vaccination in 1963, the incidence of measles decreased by more than 98 percent and the common two-to-three year outbreak cycles had completely diminished. However, beginning in 1989, a dramatic measles resurgence occurred in the U.S. and more than 55,000 cases were identified with 123 deaths (a death to case ratio of 2.2 per 1,000 cases), preschoolers exhibited the greatest fatality. In fact, during the 1989 to 1991 resurgence, 45 percent of all reported cases were children under the age of 5. Since the 1989 resurgence of measles, current cases continue to remain steady with the largest outbreaks occurring in populations that refuse vaccinations for personal, religious, or philosophical reasons.

As vaccinations have been so successful in minimizing or eliminating many diseases, they no longer serve as a reminder to parents to vaccinate their children. Instead the attention has now been diverted away from illness prevention, to unfounded concerns related to vaccine safety and toxicity. Some of the major topics that have been the center of media attention regarding vaccination safety include claims that the diphtheria-tetanus-pertussis vaccine (DTP) was associated with sudden infant death syndrome, that the hepatitis B vaccine was associated with multiple sclerosis, and the most famous one of all, that the measles-mumps-rubella (MMR) vaccine was linked to autism. However, it is very important to note that each of these hypotheses have not been supported, sustained or scientifically proven, yet continue to create a very misleading stigma for vaccinations among the general public. In fact, not receiving near as much media coverage as the original findings, the foundational study published in the Lancetby Andrew Wakefield in 1998 where he pegged the only substantial link between the MMR vaccine and autism, has now been redacted from publication and discredited as falsified and fraudulent. Wakefield was also stripped of his medical license.

Vaccinations have been so successful in minimizing or eliminating their target diseases, that they have now become the victim of their own success. These devastating illnesses no longer serve as a reminder to parents to vaccinate their children and unfortunately their perceived importance has been relegated as merely historical. People often don't fear what they do not see, which can be very unfortunate when dealing with microscopic killers.

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